From the Guidelines
Treatment of a hemolytic transfusion reaction (HTR) requires immediate action, including stopping the transfusion, maintaining IV access, and administering oxygen as needed, with first-line immunosuppressive agents such as IVIg and high-dose steroids being considered for life-threatening hemolysis. The management of HTRs involves a multi-step approach, including:
- Stopping the transfusion immediately and maintaining IV access with normal saline through a new line
- Notifying the blood bank and sending the remaining blood product for testing
- Administering oxygen as needed and monitoring vital signs closely
- Considering immunosuppressive therapy, such as IVIg and high-dose steroids, for life-threatening hemolysis, as recommended by the American Society of Hematology 2020 guidelines for sickle cell disease: transfusion support 1
- Using supportive care, including erythropoietin with or without IV iron, and considering extended matched red cells if further transfusion is warranted
- Drawing blood samples for CBC, coagulation studies, and renal function tests to monitor the severity of the reaction
- Providing intensive care support for severe reactions, which may include aggressive IV fluids, furosemide, and vasopressors, as outlined in the AAGBI guidelines: the use of blood components and their alternatives 2016 1 The severity of the reaction determines additional interventions, with mild reactions potentially only requiring antihistamines and monitoring, while severe reactions may require more aggressive treatment, including immunosuppressive therapy and intensive care support 1.
From the FDA Drug Label
Allergic states: Control of severe or incapaculating allergic conditions intractable to adequate trials of conventional treatment in asthma, atopic dermatitis, contact dermatitis, drug hypersensitivity reactions, serum sickness, transfusion reactions. The treatment for a hemolytic transfusion reaction (HTR) may include the use of methylprednisolone (IV), as it is indicated for the control of severe or incapacilitating allergic conditions, including transfusion reactions 2.
- The use of methylprednisolone (IV) should be considered in the treatment of HTR, given its indication for transfusion reactions.
- However, the specific treatment approach may vary depending on the severity and individual circumstances of the HTR.
From the Research
Treatment for Hemolytic Transfusion Reaction (HTR)
- The treatment for a hemolytic transfusion reaction (HTR) involves immediate discontinuation of the transfusion and initiation of a laboratory workup to confirm the diagnosis 3.
- A direct antiglobulin (Coombs') test should be performed, and specimens obtained before and after transfusion should be assayed for hemoglobinemia and hemoglobinuria 3.
- If the product transfused included red blood cells, then typing and crossmatching should be repeated on a posttransfusion blood specimen 3.
- There is no specific mention of treatment for HTR in the other studies, which focus on febrile non-hemolytic transfusion reactions 4, 5 and general management of transfusion reactions 6, 7.
- The management of adverse transfusion reactions, including HTR, requires awareness and prompt action by healthcare workers 7.
Prevention and Management of Transfusion Reactions
- Removal of leukocyte components from blood can reduce the incidence of febrile non-hemolytic transfusion reactions 5.
- The use of antipyretic drugs before transfusion as a prophylactic measure is controversial 4, 5.
- Education on the risk of transfusion-associated graft-versus-host-disease (TA-GVHD) is important, especially in facilities where nonirradiated blood is supplied 7.
Diagnosis of Transfusion Reactions
- Febrile non-hemolytic transfusion reactions can be diagnosed by the presence of fever, chills, shakes, headache, and nausea during or within 4 hours after transfusion 5.
- Hemolytic transfusion reactions can be diagnosed by laboratory tests, including direct antiglobulin (Coombs') test and assays for hemoglobinemia and hemoglobinuria 3.